This study is a cross sectional self-administered mailed survey to address the type and frequency of ethical dilemmas faced by physicians, how they approach them, the types of ethical support they would find useful in addressing these ethical dilemmas, and their attitudes and practices in situations of scarce resources. The questionnaire was designed, piloted, translated and back translated. Following IRB approval, the study sample included 656 general practitioners and general internists from each of four European countries including England, Switzerland, Norway and Italy. The results have been analyzed and three peer reviewed journal articles have been published, two are in press and two book chapters have been published. These publications report: 1. The ethical difficulties encountered in clinical Practice by European doctors. 2. Physicians access to ethics support services in the four european countries in the study. 3. The prevalence and determinants of physician bedside rationing in four European countries. 4. Physicians views on resource availability and equity in four European health care systems. 5. An examination of whether ethics consultants should help clinicians face scarcity in their Practices. The study has been amended to include 500 U.S. internists for comparison with the European sample. IRB approval has been attained at the NIH and OMB approval is being sought for the US survey.